Language versus actually helping people–AMA edition

Honestly, so much of what gets me about “woke” politics is an over-emphasis on language/symbolism and just not enough on the policies and material conditions that actually affect people’s lives. More on making sure we have affordable housing for Black and Hispanic people, less on renaming shopping centers for families that owned slaves when pretty much nobody knows anything about the name of the shopping center. 

I already quick-hitted Friedersdorf’s take on just how ridiculous the American Medical Association is being with their language, but Yglesias has a post emphasizing that, far more importantly, on actual policies, the AMA actively fights for position that make life more difficult for minorities: Yglesias: 

There are lots of ways to increase medical abundance, but unfortunately, the AMA is normally standing in the way — blocking increased scope of practice for nurses, making it hard for foreign-trained doctors to practice in the United States, and historically pushing to train too few doctors here at home.

It’s a trade association and, unfortunately, this is what trade associations do. The AMA is also involved in stuff like bilking Medicare out of money by overestimating how long it takes to do various procedures. Doctors don’t like Medicare because it’s so large that it uses its purchasing power to drive down unit costs — hence not only the bilking, but opposition to Medicare for All and strong versions of health care public options. It’s ancient history at this point, but AMA opposition was critical to killing Harry Truman’s universal health care proposal, and they opposed early versions of the proposals to create Medicare and Medicaid. Martin Luther King believed the AMA was complicit in upholding segregated medical facilities in the south and discriminatory treatment in the north.

Some of this was a long time ago, but some of it is very present day. And at all points in time, the key issue is what the doctors’ trade association actually does — in this case, fighting to make medical care scarce and against cost-effective forms of provision — rather than what they advise people to say…

I think it’s mostly uncontroversial to say that this kind of linguistic fussing matters less than whether or not we tackle the material roots of deprivation and inequality.

But people who agree with that tend to get a little soft and lax when it comes to following through. Because at the end of the day, the most important sense in which language matters to politics is that it marks in-groups and out-groups. More than anything else, using lots of social justice jargon marks you out as a member of one sort of community and marks people who find it confusing or alienating as non-members of the community.

Yet the core policy goals that would advance health equity — increase the supply of providers, tax the rich, expand Medicaid, create a strong public option — are all broadly popular ideas. They just also happen to be ideas that are fiercely opposed by influential (and highly focused) interest groups. Talking about how “narratives that uncritically center meritocracy and individualism render invisible the very real constraints generated and reinforced by poverty, discrimination and ultimately exclusion” often confuses people.

If you actually care about addressing these issues, you need to speak to people in language they understand and in terms of values they are sympathetic to. You also need to tackle the American Medical Association as a lobbying group. If you don’t really care about outcomes and just want to signal that you are the right kind of person, then this document’s approach is great.